Penicillin G may decrease the effectiveness of oral contraceptives. Potassium sparing diuretics such as spironolactone may cause hyperkalemia when administered with penicillin G potassium.

What contraindications/precautions should be taken when administering Penicillin G?

Patients who are allergic to any drug in the penicillin class. Cross hypersensitivity also occurs with drugs in the cephalosporin class. Patients with significant renal impairment must be carefully monitored.

Describe the Mechanism of Action for Ampicillin

Ampicillin is a drug that inhibits bacterial wall synthesis by binding PBPs. This drug is bacteriocidal and inactivated by penicillinase. Ampicillin is a Broad spectrum antibiotic.

Describe the Pharmacokinetics of Ampicillin

Ampicillin can be administered PO, IM, or IVOnly a small amount crosses the BBBIt is largely unmetabolized so renal function is very important

Describe Adverse Effects of Ampicillin

Rash and diarrhea are the most common adverse effects. Pain at the injection site is common. Watch for anaphylaxis. Pseudomembranous colitis is rare, though serious.

What contraindications/precautions should be taken when administering Ampicillin?

Ampicillin is contraindicated in patients who are allergic to any drug in the penicillin class and used cautiously in those with hypersensitivity to cephalosporins. Drug therapy must be monitored carefully in patients with renal disease.

What drug interactions may occur with Ampicillin?

Ampicillin may decrease the effectiveness of oral contraceptives. Food decreases its absorption, ampicillin should be taken on an empty stomach.

What are some Nursing Responsibilities when administering Ampicillin?

Immediately report severe or persistent diarrhea accompanied by fever. It is important to take Ampicillin around the clock to keep in a therapeutic range.

Describe the Mechanism of Action for Cefazolin (Ancef)

Cefazolin inhibits bacterial wall synthesis by binding to specific PBPs. The drug is bacteriocidal, exhibits a broad spectrum, and is sensitive to beta lactamase.

Describe the Pharmacokinetics of Cefazolin

Can be administered IM or IVThe drug is not metabolized so kidney function is CRUCIAL!!

Describe Adverse Effects of Cefazolin

Rash and diarrhea are the most common adverse effects, and superinfections are likely when the antibiotic is used for prolonged periods. Pain and phlebitis can occur at the IM injection site. Anaphylactic response is possible.

What contraindications/precautions should be taken when administering Cefazolin?

Contraindicated in patients who are allergic to any drug in the cephalosporin class. Patients with significant renal impairment must be carefully monitored.

Vancomycin is a drug given to treat severe infections that are resistant to safe antibiotics. Vancomycin kills bacteria mainly by inhibiting bacterial cell wall synthesis, it also affects the plasma membrane and interferes with ribonucleic acid synthesis.

Describe the Pharmacokinetics for Vancomycin

Infuse IV over 60 minutes with at least 200mL.Not metabolized, so Kidney function is CRUCIAL!!

Describe Adverse Effects of Vancomycin.

Vancomycin may case a syndrome of flushing, hypotension, tachycardia, and a rash on the upper body, a condition called the RED MAN SYNDROME.

What contraindications/precautions should be taken when administering Cefazolin?

Contraindicated in patients who have experienced previous hypersensitivity to this drug. Monitor carefully in patient with impaired renal function.

What drug interactions may occur with Vancomycin?

Additive toxicity with aminoglycosides and other ototoxic and nephrotoxic drugs.

What are some Nursing Responsibilities when administering Vancomycin?

Monitor BP and HRMonitor for Red Man SyndromeMay be asked to draw Peak and Trough levelsAssess patient for Hearing AbilitiesImmediately report ringing in the ears or known or suspected pregnancy

Describe the Mechanism of Action for Tetracycline

Tetracycline inhibits bacterial protein synthesis by binding to the 30S ribosome subunit, interfering with the attachment of the tRNA to the mRNA. The growing amino acid chain is prematurely terminated and protein synthesis is inhibited. It is usually considered bacteriostatic, although it can be bacteriocidal at high concentrations.

Describe the Pharmacokinetics for Tetracycline

Can be administered PO or topically Secreted in breast milk60% renal excretion

Describe Adverse Effects of Tetracycline

Superinfection due to broad spectrumDiscoloration of TeethFatty degeneration of the Liver (Liver Failure)Exfoliative DermatitisPhotosensitivity

What contraindication/precautions should be taken when administering Tetracycline?

Contraindicated in patients who are allergic to any drug in the tetracycline class. Should not be used during pregnancy. Calcium/Magnesium/Iron

What drug interactions can occur when administering Tetracycline?

Dairy products affect absorption

What are some Nursing Responsibilities when administering Tetracycline?

Administer with a full glass of water on an empty stomach.Dont take right before bedYour skin may GLOWImmediately report severe diarrheaMay be given for a skin infection so maintain skin care

Describe the Mechanism of Action for Erythromycin.

Erythromycin inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit. Erythromycin is considered bacteriostatic but may be bacteriocidal in high doses.

Describe the Pharmacokinetics of Erythromycin.

Can be administered PO, Topical, or IVPrimarily metabolized by CYP3A enzyme systemPrimarily excreted in bile

Describe Adverse Effects of Erythromycin.

NVD is most commonPhlebitis and intense pain at the injection siteHearing loss, vertigo, and dizzinessMay be Cardiotoxic

What contraindication/precautions should be taken when administering Erythromycin?

Hypersensitivity to drugs in the Macrolide class. Patients with impaired hepatic and biliary function.

What drug interactions may occur when administering Erythromycin?

Other drugs that use the CYP450 enzyme system.Use with anticoagulantsShould not be taken with Grapefruit juice

What are some Nursing Responsibilities when administering Erythromycin?

Give enteric-coated tables without regard to meals Can be applied to the eyes of newborn babies for gonerrhea. (.5 - 1 cm) into the lower conjunctival sac (Inner to outer canthus) Use a new tube for each neonateIf it's in a pediatric liquid form, SHAKE IT UP!

Describe the Mechanism of Action for Gentamicin.

Gentamicin inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit. It is bacteriocidal in that it causes premature termination of the growing polypeptide chain.

Describe the Pharmacokinetics of Gentamicin.

Most are given IM and IVWill have prolonged activity (even below therapeutic level)Not metabolized so Renal function is Crucial!

Describe Adverse Effects of Gentamicin

Neuromuscular blockade and respiratory paralysis are possible and the drug may cause severe neuromuscular weakness.

What are some contraindications/precautions that should be taken when giving Gentamicin?

Isoniazid acts by inhibiting the synthesis of mycolic acid, and essential cell-wall component of mycobacteria. It is bacteriocidal for rapidly dividing organisms, but bacteriostatic for dormant mycobacteria.

Describe the Pharmacokinetics for Isoniazid (INH)

Can be given PO or IM (IM is preferred)75% renal excretionCrosses the BBB

Describe Adverse Effects of Isoniazid (INH)

Common adverse effects of isoniazid are rash and fever.Alcohol consumption increases risk for developing hepatotoxicityBlood dyscrasias

What are some drug interactions that can occur when giving Amphotericin B (Fungizone)

MANY

What are some Nursing Responsibilities for administering Amphotericin B (Fungizone)

Premedicate with antipyretics, antihistamines, antimetics, and corticosteriods to decrease the adverse effects. Check vitals every 30 minutesNotify if no improvement in 1 to 2 weeksWash any towels and wear gloves

What are the indications for Fluconazole (Diflucan)?

Infections by Candida AlbicansMycoses resistant to other antifungals

Describe the Mechanism of Action for Fluconazole (Diflucan)

Like other azoles, fluconazole acts by interfering with the synthesis or ergosterol. Inhibitor of fungal cell membrane synthesis.

What are some contraindications/precautions to consider when giving Fluconazole (Diflucan)?

Don't give to hypokalemia patientsPreexisting renal impairment

What are some Nursing Responsibilities to consider when giving Fluconazole (Diflucan)?

Report signs of liver toxicityMonitor BUN, and liver function

What are the indications for Nystatin (Mycostatin)?

Candida infections of the vagina, skin, mouth, and intestine.

Describe the Mechanism of Action for Nystatin

Binds to sterols in the fungal cell membrane and allows leakage of intracellular contents across the weakened membrane.

Describe the Pharmacokinetics of Nystatin

Usually given PO or topicallyPoorly absorbed and not distributed

Describe Adverse Effects of Nystatin

Minor Skin irritation and burningContact dermatitisWhen given PO, NVD

What are some contraindications/precautions to consider when giving Nystatin

Hypersensitivity to the drug

What are some Nursing Responsibilities when giving Nystatin?

Avoid in dark, moist areas of the bodyStop if contact dermatitis occursDissolve troches in the mouth for about 30 minutes (dont chew or swallow)Use cream instead of ointment in body foldsUse vaginal tablets up to 6 weeks before the end of the pregnancy